Healthcare Provider Details

I. General information

NPI: 1477912822
Provider Name (Legal Business Name): RICHMOND INTERVENTIONAL PAIN MANAGEMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2016
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 RICHMOND AVE STE 202
STATEN ISLAND NY
10314-3961
US

IV. Provider business mailing address

2066 RICHMOND AVE STE 202
STATEN ISLAND NY
10314-3961
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-3900
  • Fax: 855-564-5600
Mailing address:
  • Phone: 718-698-3900
  • Fax: 855-564-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIANNE DWYER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 718-698-3900